Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

 Describing something DOES NOTHING to get stroke survivors recovered! Useless.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

• Lucio A Rinaldi &
• Vito Monaco 

Journal of NeuroEngineering and Rehabilitation volume 10, Article number: 53 (2013) Cite this article

• 3730 Accesses

• 23 Citations

• Metrics details

Abstract

Background

Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed. This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. This study aimed at examining coordinative adaptations during walking in response to unilateral brain damage, while homologous participants walked at two fixed speeds.

Methods

Five patients with left and five with right chronic hemiparesis, characterized by similar level of motor functioning, were enrolled. Ten non-disabled volunteers were recruited as matched control group. Spatio-temporal parameters, and intralimb thigh-leg and leg-foot coordination patterns were used to compare groups while walking on a treadmill at 0.4 and 0.6 m/s. The likelihood of Continuous Relative Phase patterns between healthy and hemiparetic subjects was evaluated by means of the root mean square of the difference and the cross correlation coefficient. The effects of the group (i.e., healthy vs. hemiparetics), side (i.e., affected vs.unaffected), and speed (e.g., slow vs. fast) were analyzed on all metrics using the Analysis of Variance.

Results

Spatio-temporal parameters of all hemiparetic subjects did not significantly differ from those of healthy subjects nor showed any asymmetry between affected and unaffected limbs. Conversely, both thigh-leg and foot-leg coordination patterns appeared to account for pathology related modifications.

Conclusion

Comparisons between hemiparetic and healthy gait should be carried out when all participants are asked to seek the same suitable dynamic equilibrium led by the same external (i.e., the speed) and internal (i.e., severity of the pathology) conditions. In this respect, biomechanical adaptations reflecting the pathology can be better highlighted by coordinative patterns of coupled segments within each limb than by the spatio-temporal parameters. Accordingly, a deep analysis of the intralimb coordination may be helpful for clinicians while designing therapeutic treatments.

Background

Compensatory strategies adopted by post-stroke patients to increase stability and efficiency of locomotion have been widely described in literature by spatio-temporal parameters, kinematic, and kinetic measures referring to walking both overground [1–3] and on treadmill [4, 5]. On the whole, the gait of post-stroke patients is mainly characterized by reduced speed, stride length, and cadence, decreased angular excursions at leg joints, increased energetic cost, and asymmetry in kinematic and kinetic variables [3]. Furthermore, a recent study highlighted that post-stroke patients walk with different patterns between treadmill and overground and, in particular, the treadmill enhances the asymmetry between affected and unaffected limbs, decreases the self-selected speed and the step length, and increases stance and double support percentages [6].

A cerebrovascular accident has been also shown to significantly modify the coordinative relationship of segments within (i.e., intralimb coordination) and between (i.e., interlimb coordination) lower limbs [7–9]. Specifically, previous authors have noticed that the intralimb coordinative patterns of chronic hemiparetics walking overground at their preferred speed can be characterized by asymmetry between unaffected and affected sides [7], and that the botulinum toxin injections into the rectus femoris of the paretic side can improve the thigh-leg coordination patterns of both limbs [8]. In addition, it was observed that the increase in speed positively influences the interlimb coordination of both arm and lower limb movements of acute patients undergoing intense rehabilitative treatments [9].

One of the common features of all mentioned studies [4, 6–9] is that participants were asked to walk at their self selected speeds, that is – as acknowledged by some authors [3, 4, 10] – the walking speed was not uniform across subjects, basically due to the inherent variability related to the cerebrovascular accident (i.e., different clinical picture, rehabilitative training, neuromuscular adaptation across patients).

Actually, previous authors have already highlighted the importance of considering gait metrics in relation to the walking speed when attempting to classify gait abnormality [11, 12]. This is because the velocity can be viewed as a control parameter of the dynamic system that, when scaled, involves changes of coordination even within the gait of walking alone [7, 13]. Furthermore, in a previous study, Monaco and colleagues [14] demonstrated that the gait analysis, when carried out at controlled and comparable speed, can better pinpoint features between young and elderly healthy subjects than the comparison at self-selected pace.

Concerning post-stroke patients, it is well known that the self-selected speed reflects specific compensative strategies related to their own degree of impairment such that patients walking in a wide range of preferred velocities are characterized by very different functional deficit [15]. However, the speed, per se, affects in a significant fashion gait patterns inducing relevant modifications of the hemiparetic locomotion [12, 15, 16]. As matter of the fact, the inherent instability of the affected limb prompts the patients to an early shift of the weight on the unaffected one inducing an asymmetric duration of stance and swing phases [15, 16]. In spite of this, when patients are asked to walk at faster speeds, i.e., pace comparable to healthy subjects, they show a bilateral increment of joint angular excursions and muscle activation [17], an improved symmetry in double and single support portions [15, 17], and a significant modification of the coordination of pelvis and trunk rotations [12]. The speed-related improvements of the hemiparetic gait seem to be due to more appropriate timing of lower limb muscles, better suited movement coordination, and possibly facilitation of intralimb and interlimb energy transfers [17].

According to these results, it is possible to hypothesize that part of data variability leading previous authors to characterize motor performance of post-stroke patients may have been ascribed to the wide range of speeds rather than to the pathology itself. Specifically, metrics used to describe motor deficits of locomotion, may lack of a suitable sensitivity when different groups of homogenous subjects (e.g., similar age, anthropometric features, severity of the deficit) are observed while walking at the same pace.

This methodological study aimed at investigating the attitude of both spatio-temporal parameters and intralimb coordination patterns to capture some of the neuromuscular adaptations of the hemiparetic locomotion. This goal has been achieved by comparing gait patterns of affected and unaffected sides in post-stroke hemiparetic patients to those of healthy subjects while walking on a treadmill at the same speeds.

More at link.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

I see nothing here that helps survivors recover. Useless.

 Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

• Lucio A Rinaldi &
• Vito Monaco 

Journal of NeuroEngineering and Rehabilitation volume 10, Article number: 53 (2013) Cite this article

• 3698 Accesses

• 23 Citations

• Metrics details

Abstract

Background

Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed. This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. This study aimed at examining coordinative adaptations during walking in response to unilateral brain damage, while homologous participants walked at two fixed speeds.

Methods

Five patients with left and five with right chronic hemiparesis, characterized by similar level of motor functioning, were enrolled. Ten non-disabled volunteers were recruited as matched control group. Spatio-temporal parameters, and intralimb thigh-leg and leg-foot coordination patterns were used to compare groups while walking on a treadmill at 0.4 and 0.6 m/s. The likelihood of Continuous Relative Phase patterns between healthy and hemiparetic subjects was evaluated by means of the root mean square of the difference and the cross correlation coefficient. The effects of the group (i.e., healthy vs. hemiparetics), side (i.e., affected vs.unaffected), and speed (e.g., slow vs. fast) were analyzed on all metrics using the Analysis of Variance.

Results

Spatio-temporal parameters of all hemiparetic subjects did not significantly differ from those of healthy subjects nor showed any asymmetry between affected and unaffected limbs. Conversely, both thigh-leg and foot-leg coordination patterns appeared to account for pathology related modifications.

Conclusion

Comparisons between hemiparetic and healthy gait should be carried out when all participants are asked to seek the same suitable dynamic equilibrium led by the same external (i.e., the speed) and internal (i.e., severity of the pathology) conditions. In this respect, biomechanical adaptations reflecting the pathology can be better highlighted by coordinative patterns of coupled segments within each limb than by the spatio-temporal parameters. Accordingly, a deep analysis of the intralimb coordination may be helpful for clinicians while designing therapeutic treatments.

Background

Compensatory strategies adopted by post-stroke patients to increase stability and efficiency of locomotion have been widely described in literature by spatio-temporal parameters, kinematic, and kinetic measures referring to walking both overground [1–3] and on treadmill [4, 5]. On the whole, the gait of post-stroke patients is mainly characterized by reduced speed, stride length, and cadence, decreased angular excursions at leg joints, increased energetic cost, and asymmetry in kinematic and kinetic variables [3]. Furthermore, a recent study highlighted that post-stroke patients walk with different patterns between treadmill and overground and, in particular, the treadmill enhances the asymmetry between affected and unaffected limbs, decreases the self-selected speed and the step length, and increases stance and double support percentages [6].

A cerebrovascular accident has been also shown to significantly modify the coordinative relationship of segments within (i.e., intralimb coordination) and between (i.e., interlimb coordination) lower limbs [7–9]. Specifically, previous authors have noticed that the intralimb coordinative patterns of chronic hemiparetics walking overground at their preferred speed can be characterized by asymmetry between unaffected and affected sides [7], and that the botulinum toxin injections into the rectus femoris of the paretic side can improve the thigh-leg coordination patterns of both limbs [8]. In addition, it was observed that the increase in speed positively influences the interlimb coordination of both arm and lower limb movements of acute patients undergoing intense rehabilitative treatments [9].

One of the common features of all mentioned studies [4, 6–9] is that participants were asked to walk at their self selected speeds, that is – as acknowledged by some authors [3, 4, 10] – the walking speed was not uniform across subjects, basically due to the inherent variability related to the cerebrovascular accident (i.e., different clinical picture, rehabilitative training, neuromuscular adaptation across patients).

Actually, previous authors have already highlighted the importance of considering gait metrics in relation to the walking speed when attempting to classify gait abnormality [11, 12]. This is because the velocity can be viewed as a control parameter of the dynamic system that, when scaled, involves changes of coordination even within the gait of walking alone [7, 13]. Furthermore, in a previous study, Monaco and colleagues [14] demonstrated that the gait analysis, when carried out at controlled and comparable speed, can better pinpoint features between young and elderly healthy subjects than the comparison at self-selected pace.

Concerning post-stroke patients, it is well known that the self-selected speed reflects specific compensative strategies related to their own degree of impairment such that patients walking in a wide range of preferred velocities are characterized by very different functional deficit [15]. However, the speed, per se, affects in a significant fashion gait patterns inducing relevant modifications of the hemiparetic locomotion [12, 15, 16]. As matter of the fact, the inherent instability of the affected limb prompts the patients to an early shift of the weight on the unaffected one inducing an asymmetric duration of stance and swing phases [15, 16]. In spite of this, when patients are asked to walk at faster speeds, i.e., pace comparable to healthy subjects, they show a bilateral increment of joint angular excursions and muscle activation [17], an improved symmetry in double and single support portions [15, 17], and a significant modification of the coordination of pelvis and trunk rotations [12]. The speed-related improvements of the hemiparetic gait seem to be due to more appropriate timing of lower limb muscles, better suited movement coordination, and possibly facilitation of intralimb and interlimb energy transfers [17].

According to these results, it is possible to hypothesize that part of data variability leading previous authors to characterize motor performance of post-stroke patients may have been ascribed to the wide range of speeds rather than to the pathology itself. Specifically, metrics used to describe motor deficits of locomotion, may lack of a suitable sensitivity when different groups of homogenous subjects (e.g., similar age, anthropometric features, severity of the deficit) are observed while walking at the same pace.

This methodological study aimed at investigating the attitude of both spatio-temporal parameters and intralimb coordination patterns to capture some of the neuromuscular adaptations of the hemiparetic locomotion. This goal has been achieved by comparing gait patterns of affected and unaffected sides in post-stroke hemiparetic patients to those of healthy subjects while walking on a treadmill at the same speeds.

More at link.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

 You described something, but it is useless in getting survivors recovered! I'd fire everyone involved in this.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

patio-temporal parameters and intralimbcoordination patterns describing hemipareticlocomotion at controlled speed
Lucio A Rinaldi
1
and Vito Monaco
2*

Abstract

Background:
 Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed. This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. This study aimed at examining coordinative adaptations during walking in response to unilateral brain damage, while homologous participants walked at two fixed speeds.
Methods:
 Five patients with left and five with right chronic hemiparesis, characterized by similar level of motor functioning, were enrolled. Ten non-disabled volunteers were recruited as matched control group. Spatio-temporal parameters, and intralimb thigh-leg and leg-foot coordination patterns were used to compare groups while walking on a treadmill at 0.4 and 0.6 m/s. The likelihood of Continuous Relative Phase patterns between healthy and hemiparetic subjects was evaluated by means of the root mean square of the difference and the cross correlation coefficient. The effects of the group (i.e., healthy vs. hemiparetics), side (i.e., affected vs.unaffected), and speed(e.g., slow vs. fast) were analyzed on all metrics using the Analysis of Variance.
Results:
 Spatio-temporal parameters of all hemiparetic subjects did not significantly differ from those of healthy subjects nor showed any asymmetry between affected and unaffected limbs. Conversely, both thigh-leg and foot-leg coordination patterns appeared to account for pathology related modifications.
Conclusion:
 Comparisons between hemiparetic and healthy gait should be carried out when all participants are asked to seek the same suitable dynamic equilibrium led by the same external (i.e., the speed) and internal(i.e., severity of the pathology) conditions. In this respect, biomechanical adaptations reflecting the pathology can be better highlighted by coordinative patterns of coupled segments within each limb than by the spatio-temporal parameters. Accordingly, a deep analysis of the intralimb coordination may be helpful for clinicians while designing therapeutic treatments.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

 Lots of words but nothing that is of any use to survivors for recovery. Useless.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

 
RESEARCH Open Access
Spatio-temporal parameters and intralimbcoordination patterns describing hemipareticlocomotion at controlled speed
Lucio A Rinaldi
1
and Vito Monaco
2*

Abstract

Background:
 

Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed. This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. This study aimed at examining coordinative adaptations during walking in response to unilateral brain damage, while homologous participants walked at two fixed speeds.
 

Methods:
 

 Five patients with left and five with right chronic hemiparesis, characterized by similar level of motor functioning, were enrolled. Ten non-disabled volunteers were recruited as matched control group. Spatio-temporal parameters, and intralimb thigh-leg and leg-foot coordination patterns were used to compare groups while walking on a treadmill at 0.4 and 0.6 m/s. The likelihood of Continuous Relative Phase patterns between healthy and hemiparetic subjects was evaluated by means of the root mean square of the difference and the cross correlation coefficient. The effects of the group (i.e., healthy vs. hemiparetics), side (i.e., affected vs.unaffected), and speed(e.g., slow vs. fast) were analyzed on all metrics using the Analysis of Variance.
 

Results:
 

 Spatiotemporal parameters of all hemiparetic subjects did not significantly differ from those of healthy subjects nor showed any asymmetry between affected and unaffected limbs. Conversely, both thigh-leg and foot-leg coordination patterns appeared to account for pathology related modifications.
 

Conclusion:
 

 Comparisons between hemiparetic and healthy gait should be carried out when all participants areasked to seek the same suitable dynamic equilibrium led by the same external (i.e., the speed) and internal(i.e., severity of the pathology) conditions. In this respect, biomechanical adaptations reflecting the pathology can be better highlighted by coordinative patterns of coupled segments within each limb than by the spatiotemporal parameters. Accordingly, a deep analysis of the intralimb coordination may be helpful for clinicians while designing therapeutic treatments.
Keywords:
 Hemiparetic gait, Fixed speeds, Spatiotemporal parameters, Intralimb coordination, Stroke
Background
Compensatory strategies adopted by post-stroke patients to increase stability and efficiency of locomotion have been widely described in literature by spatiotemporal parameters, kinematic, and kinetic measures referring to walking both overground [1-3] and on treadmill [4,5]. On the whole, the gait of post-stroke patients is mainly characterized by reduced speed, stride length, and cadence,decreased angular excursions at leg joints, increased energetic cost, and asymmetry in kinematic and kinetic variables [3]. Furthermore, a recent study highlighted that post-stroke patients walk with different patterns between treadmill and overground and, in particular, the treadmill enhances the asymmetry between affected and unaffected limbs, decreases the self-selected speed and the step length,and increases stance and double support percentages [6]. A cerebrovascular accident has been also shown to significantly modify the coordinative relationship of segments within (i.e., intralimb coordination) and between (i.e.,interlimb coordination) lower limbs [7-9]. Specifically, previous authors have noticed that the intralimb coordinative patterns of chronic hemiparetics walking overground at their preferred speed can be characterized by asymmetry between unaffected and affected sides [7], and that the botulinum toxin injections into the rectus femoris of the paretic side can improve the thigh-leg coordination patterns of both limbs [8]. In addition, it was observed that the increase in speed positively influences the  interlimb coordination of both arm and lower limb move-ments of acute patients undergoing intense rehabilitative treatments [9].One of the common features of all mentioned studies[4,6-9] is that participants were asked to walk at their self selected speeds, that is
 –
 as acknowledged by some authors [3,4,10]
 –
 the walking speed was not uniform across subjects, basically due to the inherent variability related to the cerebrovascular accident (i.e., different clinical picture, rehabilitative training, neuromuscular adaptation across patients).  Actually, previous authors have already highlighted the importance of considering gait metrics in relation to the walking speed when attempting to classify gait abnormality [11,12]. This is because the velocity can be viewed as a control parameter of the dynamic system that, when scaled, involves changes of coordination even within the gait of walking alone [7,13]. Furthermore, in a previous study, Monaco and colleagues [14] demonstrated that the gait analysis, when carried out at controlled and comparable speed, can better pinpoint features between young and elderly healthy subjects than the comparison at self-selected pace.Concerning post-stroke patients, it is well known that the self-selected speed reflects specific compensative strategies related to their own degree of impairment such that patients walking in a wide range of preferred velocities are characterized by very different functional deficit [15]. However, the speed, per se, affects in a significant fashion gait patterns inducing relevant modifications of the hemiparetic locomotion [12,15,16]. As matter of the fact, the inherent instability of the affected limb prompts the patients to an early shift of the weight on the unaffected one inducing an asymmetric duration of stance and swing phases [15,16]. In spite of this, when patients are asked to walk at faster speeds, i.e.,pace comparable to healthy subjects, they show a bilateral increment of joint angular excursions and muscle activation [17], an improved symmetry in double and single support portions [15,17], and a significant modification of the coordination of pelvis and trunk rotations[12]. The speed-related improvements of the hemiparetic gait seem to be due to more appropriate timing of lower limb muscles, better suited movement coordination, and possibly facilitation of intralimb and interlimb energy transfers [17]. According to these results, it is possible to hypothesize that part of data variability leading previous authors to characterize motor performance of post-stroke patients may have been ascribed to the wide range of speeds rather than to the pathology itself. Specifically, metrics used to describe motor deficits of locomotion, may lack of a suitable sensitivity when different groups of homogenous subjects (e.g., similar age, anthropometric features, severity of the deficit) are observed while walking at the same pace.This methodological study aimed at investigating the attitude of both spatiotemporal parameters and intralimb coordination patterns to capture some of the neuromuscular adaptations of the hemiparetic locomotion. This goal has been achieved by comparing gait patterns of affected and unaffected sides in post-stroke hemiparetic patients to those of healthy subjects while walking on a treadmill at the same speeds.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

 I see nothing here that tells survivors EXACTLY how to recover walking. So more useless research. Damn, a lot of people supposedly working in stroke need to be fired.

Spatio-temporal parameters and intralimb coordination patterns describing hemiparetic locomotion at controlled speed

 
RESEARCH Open Access
Lucio A Rinaldi 1
and Vito Monaco 2*

Abstract

Background:
 

Comparison between healthy and hemiparetic gait is usually carried out while subjects walk overground at preferred speed. This generates bias due to the lack of uniformity across selected speeds because they reflect the great variability of the functional level of post-stroke patients. This study aimed at examining coordinative adaptations during walking in response to unilateral brain damage, while homologous participants walked at two fixed speeds.
Methods:
 

 Five patients with left and five with right chronic hemiparesis, characterized by similar level of motor functioning, were enrolled. Ten non-disabled volunteers were recruited as matched control group. Spatio-temporal parameters, and intralimb thigh-leg and leg-foot coordination patterns were used to compare groups while walking on a treadmill at 0.4 and 0.6 m/s. The likelihood of Continuous Relative Phase patterns between healthy and hemiparetic subjects was evaluated by means of the root mean square of the difference and the cross correlation coefficient. The effects of the group (i.e., healthy vs. hemiparetics), side (i.e., affected vs.unaffected), and speed(e.g., slow vs. fast) were analyzed on all metrics using the Analysis of Variance.
Results:
 

Spatio-temporal parameters of all hemiparetic subjects did not significantly differ from those of healthy subjects nor showed any asymmetry between affected and unaffected limbs. Conversely, both thigh-leg and foot-leg coordination patterns appeared to account for pathology related modifications.
Conclusion:
 

Comparisons between hemiparetic and healthy gait should be carried out when all participants are asked to seek the same suitable dynamic equilibrium led by the same external (i.e., the speed) and internal(i.e., severity of the pathology) conditions. In this respect, biomechanical adaptations reflecting the pathology can be better highlighted by coordinative patterns of coupled segments within each limb than by the spatio-temporal parameters. Accordingly, a deep analysis of the intralimb coordination may be helpful for clinicians while designing therapeutic treatments.
Keywords:
 Hemiparetic gait, Fixed speeds, Spatio-temporal parameters, Intralimb coordination, Stroke
Background
Compensatory strategies adopted by post-stroke patients to increase stability and efficiency of locomotion have been widely described in literature by spatio-temporal parameters, kinematic, and kinetic measures referring to walking both overground [1-3] and on treadmill [4,5]. On the whole, the gait of post-stroke patients is mainly characterized by reduced speed, stride length, and cadence,decreased angular excursions at leg joints, increased energetic cost, and asymmetry in kinematic and kinetic variables [3]. Furthermore, a recent study highlighted that post-stroke patients walk with different patterns between treadmill and overground and, in particular, the treadmill enhances the asymmetry between affected and unaffected limbs, decreases the self-selected speed and the step length,and increases stance and double support percentages [6]. A cerebrovascular accident has been also shown to significantly modify the coordinative relationship of segments
* Correspondence: v.monaco@sssup.it
2
Istituto di BioRobotica, Scuola Superiore Sant
’
Anna, P.za Martiri della Libertà,33, 56127, Pisa, I, ItalyFull list of author information is available at the end of the article
JNER
 JOURNAL OF NEUROENGINEERINGAND REHABILITATION
© 2013 Rinaldi and Monaco; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of theCreative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,distribution, and reproduction in any medium, provided the original work is properly cited.
Rinaldi and Monaco
 Journal of NeuroEngineering and Rehabilitation
 2013,
 10
:53http://www.jneuroengrehab.com/content/10/1/53

Characteristics of Intralimb Kinetic Coordination in the Lower Limbs During Gait in Patients with Hemiparesis Due to Stroke

But you didn't answer the overriding question! Did survivor walking improve?  You didn't measure the 10 meter walking test? Or the Berg Balance Scale? And you're obviously not learning the right things at University.  Bad teaching.

“What's measured, improves.” So said management legend and author Peter F. Drucker 

The latest here:

Characteristics of Intralimb Kinetic Coordination in the Lower Limbs During Gait in Patients with Hemiparesis Due to Stroke

Yusuke Sekiguchi,1 Dai Owaki,2 Keita Honda,1 Shin-ichi Izumi1,3
1Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of
Medicine, 2-1, Seiryo-machi, Sendai 980-8575, Japan
2Department of Robotics, Graduate School of Engineering, Tohoku University, 6-6-01Aoba,
Aramaki, Aoba-ku, Sendai, 980-8579, Japan
3Graduate School of Biomedical Engineering, Tohoku University, 2-1, Seiryo-machi, Sendai
980-8575, Japan

Abstract

Background: 

 

The main objective of the present study is to investigate the relationship
between the principal components (PCs) of the sagittal kinetic variables in the lower limb and the ground reaction forces (GRFs) during gait in patients with hemiparesis.
 

Methods: 

 

We recruited 21 patients with hemiparesis and 12 healthy 

controls. The 3-dimensional (3-D) coordinates of 33 markers were measured with a 3-D motion analysis system operating at 120 Hz and force plates as the subjects walked along a 7-meter walkway. The correlation coefficients between the over-time series of PCs, which is calculated using principle component analysis (PCA), and GRFs were compared among the left side of the controls and the paretic side (PS) and non-PS of the patients by using analysis of variance(ANOVA).
 

Results: 

 

The correlation coefficient of the non-PS between the first PC and GRF in the anteroposterior-direction was significantly higher than that on the PS (P < 0.05) and that of the non-PS in the vertical-direction was lower than the PS (P < 0.05).
 

Conclusions: 

 

The results indicated that intralimb kinetic coordination on the PS plays an essential role in weight support in patients with hemiparesis, whereas the kinetic coordination on the non-PS plays a role in generation of propulsion.

Quantifying intra- and interlimb use during unimanual and bimanual tasks in persons with hemiparesis post-stroke

 Quantifying DOES NOTHING FOR STROKE RECOVERY! Useless.

You just might want it solved before you become the 1 in 4 per WHO that has a stroke.

Quantifying intra- and interlimb use during unimanual and bimanual tasks in persons with hemiparesis post-stroke

• Susan V. Duff,
• Aaron Miller,
• Lori Quinn,
• Gregory Youdan Jr.,
• Lauri Bishop,
• Heather Ruthrauff &
• Eric Wade 

Journal of NeuroEngineering and Rehabilitation volume 19, Article number: 44 (2022) Cite this article

• 85 Accesses

• 1 Altmetric

• Metrics details

Abstract

Background

Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited.

Objective

To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance.

Methods

Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into one motion parameter, per sensor pair, using a novel algorithm. This motion parameter was compared in a group-by-task analysis of variance as a similarity score (0–1) between key sensor pairs: sternum to wrist, wrist to wrist, and wrist to upper arm. A use ratio (paretic/non-paretic arm) was calculated in persons post-stroke from wrist sensor data for each modality and compared to scores from the Adult Assisting Hand Assessment (Ad-AHA Stroke) and UE Fugl-Meyer (UEFM).

Results

A significant group × task interaction in the similarity score was found for all key sensor pairs. Post-hoc tests between task type revealed significant differences in similarity for sensor pairs in 8/9 comparisons for controls and 3/9 comparisons for persons post stroke. The use ratio was significantly predictive of the Ad-AHA Stroke and UEFM scores for each modality.

Conclusions

Our algorithm and sensor data analyses distinguished task type within and between groups and were predictive of clinical scores. Future work will assess reliability and validity of this novel metric to allow development of an easy-to-use app for clinicians.

Introduction

Finely tuned upper extremity (UE) intra- and interlimb use is controlled through intact neural coupling [1], which requires timing of movements and sequential, rhythmic use of limb segments on one or both sides of the body [2]. This upper limb coupling enables interaction with the environment and the performance of goal-oriented tasks such as activities of daily living (ADLs). The type of tasks performed range from unimanual (single limb use), to bimanual symmetric (mirrored), to bimanual asymmetric with different motion exhibited in each limb. For persons with hemiparesis post-stroke, tasks requiring UE coupling can be difficult to execute due to limited strength, mobility, and motor control resulting in the execution of compensatory, yet functional, movement patterns [3,4,5]. Compensatory strategies may include increased trunk involvement during arm motion, limb disuse or asymmetry during mirrored bimanual tasks, and inefficient motion or atypical synergistic movements during task performance [6,7,8]. Although compensation promotes independence in everyday tasks, it can also impede recovery of intra- and interlimb use inherent in unimanual and bimanual performance [5, 9]. Determining the extent of coupling within and between the arms and how it changes with recovery and rehabilitation requires assessment measures sensitive to subtle changes in motion and task performance.

Most UE clinical assessments evaluate function of the paretic limb during unimanual tasks with limited emphasis on bimanual function [10,11,12]. An exception to this is the Assisting Hand Assessment (AHA) [13, 14], a tool originally designed to assess how effectively the more affected limb is used during bimanual tasks in children with unilateral UE dysfunction. The AHA has been recently adapted for use in adults post-stroke, i.e. the Adult AHA Stroke (Ad-AHA Stroke) [15]. However, as with other observation-based tools, the Ad-AHA Stroke may not be sensitive enough to detect small yet significant changes in motor behavior occurring with natural recovery or rehabilitation. A highly sensitive, objective measure requiring minimal equipment is needed to quantify intra- and interlimb use across a range of tasks and settings.

Inertial measurement units (IMU), are body-worn sensors that monitor and transmit changes in movement during the execution of everyday tasks [16]. IMU sensors have been used with individuals post-stroke and other neurological conditions, to capture the quality and quantity of motion during typical and atypical motor behaviors [16, 17]. These sensors can detect quantitative changes in movement patterns that differentiate between typical and atypical motor behavior. A challenge in using IMU sensors is that they produce derived, differential motion measures, such as linear acceleration and angular rate of change. Therefore, unlike traditional marker-based motion capture systems, raw data cannot be easily used to directly reconstruct changes in limb position. Instead, IMU data requires custom signal and data processing techniques to produce clinically relevant metrics [18].

Development of an accurate yet sensitive system using IMU data to identify distinct features of UE intra- and interlimb use is a sequential process. For our purposes, we operationalize intra- and interlimb use in regard to amplitude, time domain and frequency domain. Results of our pilot work suggest that development of a single motion parameter per sensor, using a novel algorithm, would allow comparison by task type between groups and allow for initial validation against widely used clinical measures [19]. The objectives of this current study were to: (1) evaluate the ability of sensor-derived motion parameters to distinguish between UE task type (unimanual, bimanual symmetric, and bimanual asymmetric tasks) in healthy controls; (2) evaluate the ability of motion parameters to differentiate between UE intra- and interlimb use in healthy controls and individuals post stroke; and (3) validate findings from sensor-derived motion parameters against clinical measures commonly used to assess performance in persons post-stroke, including the UE Fugl-Meyer (UEFM) and the Ad-AHA Stroke Assessments.

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